Alone
Alone is the 4th season premiere episode of House which first aired on September 25, 2007. With House's team all having either resigned or been fired, House tries to convince everyone that he doesn't need a team to do his job. When a victim of a structural collapse develops a fever after surgery, he goes to work. He quickly reaches a series of diagnoses, only to have new symptoms pop up seemingly out of nowhere. Meanwhile, a diabolical kidnapper strikes and demands a unique ransom, but House refuses to give in to the "terrorism" and strikes back by taking a hostage of his own. Recap A woman thinks she is hallucinating because the building she is in seems to be shaking. She complains of dizziness during a phone call with her boyfriend Ben, and suddenly the building collapses with the woman inside and a stunned Ben recovering in the parking lot. Lisa Cuddy presents Gregory House with a case. A gas main exploded and the patient was buried under rubble for six hours. She's running a high fever. They start arguing about House hiring a new team, but he stands there playing his guitar until Cuddy yanks the guitar cord out of the amp, then threatens to make him change bandages on the trauma victims. He agrees to take the case if Cuddy agrees to give him a week off if he solves the case within a day. Wilson finds out and tells Cuddy it's a bad idea. House is writing on his whiteboard and bouncing ideas of the hospital's janitor. For five dollars, the janitor starts guessing mechanical problems for a floor buffer, which House translates into possible diagnoses and then rejects them. The janitor then guesses lupus. House resigns himself to speaking to the family. The janitor is still there taking notes for House and is introduced as “Dr. Buffer“. When the patient's boyfriend expresses worry, the janitor comforts him. House suggests an environmental scan of the house without the patient’s permission, but the janitor refuses and holds out for fifty dollars. House won't fork it over. House recruits Wilson to break into the patient's home on the pretext he's taking him to lunch. House pretends to be in pain while searching the home, so Wilson helps out by taking samples from hard to reach places, like under sinks. While House is resting on the patient's bed, he finds the patient's diary. It shows her mood has improved. House thinks the patient might be suffering from a mix of antidepressants and demerol. The boyfriend denies that the patient, Megan, is on anti-depressants while the janitor tries to get them to sign a consent for dialysis. The patient's family finally learns the "assistant" is a janitor. House is trying to convince the family, particularly the mother who is her proxy. The family goes to Cuddy, who rebukes House on his conduct, but supports his diagnosis. The mother agrees to the dialysis. When House returns to his office, he finds a ransom note for his guitar. Wilson calls with a ransom demand, using a handheld electric fan in a futile attempt to disguise his voice, but House barges into his office. Wilson pretends not to know anything about House‘s guitar, but his newspaper is the obvious source of the note. Wilson says the ransom is "what every kidnapper wants"—to see House start interviewing applicants. House says he solved the case alone and doesn’t need a team. The patient's fever goes down and she regains consciousness but can't talk. She can communicate by blinking, and confirms House’s diagnosis that she was on antidepressants. Suddenly her heart starts racing and she goes into cardiac arrest. The patient is shocked back into sinus rhythm but is still suffering from a tachycardia. House says he won the bet he had with Cuddy because he explained the fever and was right about the anti-depressants. He also finds a photo of his guitar with the caption “I‘m not dead yet“. He starts bouncing ideas off Cuddy. He finally gives up and asks Wilson for the resumes and his guitar. Wilson gives him the resumes and suggests the guitar will be returned after the interviews. House goes back to working with Cuddy. He thinks the heart problem is the result of the trauma. House explains how it could have developed two days after the collapse. However, House does an echocardiogram, and her heart is fine. Not only that, the fever returns. House thinks it might be the DTs - alcohol withdrawal. There is no test to confirm it, so House suggests giving her "hair of the dog". The boyfriend can't believe she was a secret drunk, but the mother agrees to give her intravenous alcohol. House starts arranging interviews, but the candidates are not very promising. House pages Wilson in the middle of the night to get him out of his house so he can search it for his guitar. House threatens to erase "El Fuego del Amor" ("The fire of love"), a telenovela that Wilson is recording on his TiVo while he is learning Spanish. House starts erasing the episodes, and Wilson threatens to escalate. The patient's fever drops and her heart starts working again. It appears House was right about the patient being an alcoholic. However, they notice the patients lips are moving and Cuddy believes she is screaming. Cuddy tells House the patient now has pancreatitis. House blames it on the alcohol they used in the treatment. Cuddy doesn't argue and becomes unresponsive. House reminds her that if he’s wrong, the patient will die. She says she's not interested in what House has to say and that House needs a team to bounce ideas off of. House is in his office thinking through the case when Cuddy comes in to seek his help again. Cuddy wonders why the patient is lying and the boyfriend didn't know about the depression or alcoholism. However, House is distracted. House finds the bridge of his guitar in a box in his office and confronts Wilson. He says he doesn’t need a team. Wilson threatens further harm by describing what happens when you over-tighten the strings on a guitar. House performs an MRI on the patient. Wilson comes in and wonders why House isn’t playing the game and doesn't want another team. House wants to focus on his MRI. He can‘t find any abnormalities in the pancreas, but realizes she is about to start bleeding. Wilson tells him to get over the hurt he is feeling from the loss of his team. The patient is now bleeding internally. They start surgery to stop it. Cuddy finally breaks down and admits to House the pancreatitis was the result of the internal bleeding, not the alcohol. House puts the bleeding down to the injuries, but Cuddy wonders why she started bleeding from five sites simultaneously days after the injury. She thinks House has been wrong every step of the way even though the treatments have worked. House tells Cuddy that if he had a team he wouldn’t be there, but without one he has noticed that that the patient has an enlarged uterus—she recently had an abortion that wasn't in the medical history. He figures she did it to hide it from her boyfriend, who said they were planning to have kids. She is bleeding because she is on the Pill, a blood thinner, which interacted with the other blood thinners she was given after her hip surgery. House looks for the mother, but finds the boyfriend who is comforting another man whose girlfriend, also caught in the collapse, has died. The boyfriend confronts him about the patient's abortion. He doesn't believe House because they've been trying to have kids, but agrees to the treatment. Pretending to be working for Wilson, House visits a cancer patient and moves him to another room in the hospital. The treatment with tamoxifen for the thinned blood has an adverse result on the patient. House still refuses to admit he was wrong even though the patient is crashing. Cuddy is wondering how one patient has three different disorders. House enters the ER and tries to bounce ideas off the doctors working there. A young woman doctor tells him the doctors have been given a memo from Cuddy instructing them not to help him. However, she later meets House in the hall to suggest diagnoses. House thinks she is looking for a job. When House asks why both her diagnoses of ARDS and crush syndrome can't both be right, she answers because then the patient would have no hope. House tells her to send him her resume and he will put it on top of the pile "that I'm never gonna look at". House goes to talk to the boyfriend. He thinks the female doctor was right, but then he notices a lump on her arm. He orders a biopsy. House issues his own memo telling everyone to ignore Cuddy's memo. Dr. Imelda finds granulomas, indicating an allergic reaction, but the only drug that she’s been exposed to while in the hospital that could cause an allergic reaction is the antibiotic cephalosporin, which she also took two months ago for strep throat with no adverse reaction. The mother is furious that every procedure they've done on the patient has caused another disease. Wilson finds that his patient is missing, realizes House did it, and confronts him. Wilson warns House that if his patient is given the wrong meds because the nurses do not know who he is, it would be a disaster. At that point House finally realizes they haven't been treating the patient they thought they were treating. It wasn't Megan but one of her friends, Liz Masters, whose medical history shows clinical depression, alcoholism, a recent abortion and an allergy to cephalosporin. The boyfriend claims it's Megan, but House tells them Liz has the same build and hair color, and emergency personnel never question family identifications. When the patient says her name, Liz, the family realizes House is right and Megan is gone. House reminds the boyfriend that Megan never did lie to him. The patient is reunited with her boyfriend, who thought she was dead while Megan's mother breaks down in tears, grief-stricken. House tells Cuddy he did it all by himself, but Cuddy reminds him that the patient almost died. Cuddy tells him that his old team would have solved it earlier—Cameron would never have believed the boyfriend didn't know his girlfriend had depression and was pregnant, Foreman would not have believed it was multiple diseases and would have tried to prove him wrong, and Chase would have backed House up by trying to prove him right. She orders him to hire a new team. House gets his guitar back. He's talking about how smart he is but how he sometimes needs help. He tells the interviewees that they can look forward to a grueling interview before stating that they should wear a cup. The camera then pulls back to show a room full of forty doctors. Zebra Factor 10/10 Although the diseases in the episode are rather common, hospital mixups of this nature are rare. There is really only one other case of a misidentified patient after a disaster, and in that case the care was entirely appropriate in any event. More common is patient mix-ups of well identified patients, leading to mistaken surgical procedures. The situation is improving as all members of the surgical team are given authority and responsibility for checking the identity of each patient. A real-life case of mistaken identity happened after a bus crash in Saskatchewan, Canada. https://www.cbc.ca/news/canada/saskatchewan/coroner-mixup-humboldt-broncos-fatal-collision-1.4668594 Major Events * It's revealed that two weeks have passed since House's original diagnostic team quit. * House's guitar mysteriously disappears. Wilson mentions that it's a 12-thousand-dollar 1967 flying V guitar. * House refuses to hire a team on the grounds that he doesn't need them and that he's gotten smarter. * House and Wilson start playing pranks on each other, House because he wants his guitar back and Wilson because he wants House to hire a team. * House tries to figure out what's wrong with a young woman who was the victim of a building collapse. * The patient's problems turn out to be due to a case of mistaken identity. The patient is shown to be Liz Masters while Megan, her friend, is the body in the morgue. * Following the case, House begins the process of selecting a new team from over forty applicants. Trivia & Cultural References *Omar Epps, Jennifer Morrison and Jesse Spencer all got credit for this episode, even though none of them appear. *The lead-in scene is probably an homage to the movie He Was a Quiet Man - The building collapse, the allusion to a hallucination, the brunette by the water cooler, and the focus on the hula girl are all key elememts in the film. *Ben talks about the “Pre-Lucasized” version of Star Wars. This was the version that existed before 1997 when George Lucas re-edited the film to add additional scenes and special effects that could not be accomplished when the film was originally released in 1977. *Eddie Van Halen is the lead guitarist for the band Van Halen. *House turning to a janitor for help with his case is reminiscent of the story from Son of Coma Guy where House recalls running into whom he thought was a janitor in a Japanese hospital. That janitor turned out to be the most talented doctor in the hospital as well as a burakumin, a member of an “untouchable” caste in feudal Japan that still faces discrimination in parts of Japan to this day. *House’s guitar is a Gibson Flying V. It was originally made from 1957 to 1959, but when several famous guitarists embraced the Flying V in the 1960s, Gibson started to re-issue it in 1967. *A Telenovela is a long run romantic daily television drama series that is common in Latin American countries. Unlike a soap opera, a telenovela has a distinct storyline that usually lasts less than a year, but averages about 120 episodes. *Raid on Entebbe is a film based on a real life Israeli operation to rescue hostages being held by PLF terrorists from an airport in Uganda. *TiVo is a brand of digital video recorder which has its own programming service which is sold by subscription. *House’s jibe about his coming from “Apes, if you believe Democrats” is a reference to the tendency of American liberals to be more likely to accept the theory of Evolution. Cast *Hugh Laurie as Gregory House *Lisa Edelstein as Lisa Cuddy *Omar Epps as Eric Foreman (credit only) *Robert Sean Leonard as James Wilson *Jennifer Morrison as Allison Cameron (credit only) *Jesse Spencer as Robert Chase (credit only) *Conor Dubin as Ben *Kay Lenz as Mrs. Bradberry *Maurice Godin as Lawrence Hourani *Pat Millicano as Leon *Bevin Prince as Megan Bradberry *Liliya Toneva as Liz Masters *Xhercis Mendez as Dr. Imelda *Kathryn Adams as Young Doctor *Leo Vargas as Male Nurse *Ken Takemoto as Sam Lee *Shannon McClung as Doug *Bobbin Bergstrom as Nurse Links *Episode page at IMDB *Episode article at Wikipedia *Episode page at House MD Guide *Episode review at Blogcritics *Episode transcript at Clinic Duty *Episode article at The TV IV *Episode page at TV.com *A review of the medicine at Polite Dissent *Episode page at Ace Showbiz Category:Episodes 2007/09/25 Category:Season 4 Category:Zebra Factor 10